Case 36

HPI: 75 y F unknown past medical history, history limited due to language barrier (speaks French Creole), presents complaining of abdominal pain for unknown amount of time (patient points to abdomen as site of pain).

Review of Systems: Limited due to above

PE:
Vitals 98.9 F, 100 HR, 18 RR, 90/56 BP, 98% on RA
Card: Tachycardic, no m or g; 2+ radial pulses, cap refill <3 sec
Lungs: CTAB, no resp distress
Abdomen: soft, non distended; palpable mass, not tender to palpation
Ext: warm, no low ext edema bilaterally
Neuro: alert, oriented, grossly unremarkable
CXR: no radiographic evidence of acute cardiopulmonary disease

QUESTIONS:

  1. What ultrasound exam can aid the emergency physician in diagnosing patients with hypotension?
  2. Image 1 was obtained with curvilinear probe on Abdomen. What is the object featured in image?
  3. Is the object normal?
  4. With color flow, Image 2 was obtained.  Is there anything abnormal?
  5. What is this patient’s diagnosis?
Image 1

Image 1

Image 2

Image 2

ANSWERS:

  1. RUSH Exam (see Image 3 below)
  2. Aorta
  3. No, aorta enlarged with endovascular hyperechoic structure (metal stent).
  4. Yes, there is flow below the vessel.
  5. Leaking abdominal aortic aneurysm post endovascular repair.
Image 3: RUSH exam imaging locations

Image 3: RUSH exam imaging locations